Abstract
Why do nurses in training continue to draw on the ideal of compassion when responding to their experiences of nursing work in the UK National Health Service (NHS), despite the difficulties that they face in developing compassionate, long-term relationships with patients in practice? To answer this question, we draw from a psychosocial analysis of focus group data from 49 trainee nurses in the NHS. First, we show how this ideal leads them to blame qualified nurses for failures in patient care. We suggest this is an unconscious defence against the anxiety evoked both by the vulnerability of their position as those who need to gain access to the profession, and of being unable to conduct compassionate nursing work. Second, we emphasize that less powerful occupational groups, such as trainee nurses, may adopt defences that underpin dominant organizational policy, such as idealization, despite further disadvantaging their group and benefitting those in power. We conclude by questioning the particular emphasis on compassion in nurses’ training, which can prevent occupational solidarity and the ability to reflect on the structural and organizational factors required to conduct patient-centred nursing work.
Highlights
In the last decade, there has been an active promotion of a more patient-centred and compassionate approach to nursing work in the UK
Our first contribution is to the compassion literature (Pedersen and Roelsgaard Obling, 2019; Simpson et al, 2014), which is to explore the unconscious reasons for the persistence of the ideal of compassion, despite practical difficulties healthcare workers experience in exercising compassion in their work
We show that the process of idealization, splitting and blame is internalized by trainee nurses and unconsciously protects them from anxiety evoked by the vulnerability of their position as those who need to gain access to the profession and when being unable to conduct compassionate nursing work, because of practical difficulties
Summary
There has been an active promotion of a more patient-centred and compassionate approach to nursing work in the UK. While systems psychodynamics perspectives have long explored how psychic and unconscious motivations interact with dominant political forces (Petriglieri and Petriglieri, 2020), psychosocial studies contribute by investigating defences in relation to wider structures of discourse (Hollway and Jefferson, 2000). We draw from this perspective to explore how the compassion discourse is bound up with trainee nurses’ unconscious psychic experiences (Gough, 2004; Kenny and Fotaki, 2014) and how trainees invest in this discourse as it protects them from anxiety and supports their self-narratives (Ford, 2010: 53). Psychosocial studies, allow consideration of the performative and unconscious effects of discourse, which we elaborate in the following
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